The primary goal in treating patients with glaucoma has been to prevent or minimize the loss of visual function. The standard approach to treatment in the United States has been to prescribe medications that reduce the intraocular pressure. When medical management fails, attempts are made to reduce the intraocular pressure using argon laser trabeculoplasty followed, if necessary, by filtration surgery. Glaucoma patients managed by medical therapy to reduce their intraocular pressure often report serious, disturbing side effects. These include brow ache, ocular irritation, unsightly red eyes, palpitations, fatigue confusion, loss of appetite, weight loss, poor vision in dim light and others. In addition, risks of certain medical therapies for glaucoma also include cardiac arrhythmia, acid base imbalance, hypokalemia, and blood dyscrasias. Thus, treatments that may be beneficial in terms of reducing intraocular pressure may also have side effects that impact on the general quality of the patient's everyday life--the patient's ability to perform common tasks and the patient's life satisfaction. Therefore, the ophthalmologist strives, in treating glaucoma, to maintain the quality of an individual patient's visual function without causing iatrogenic effects which might offset the rewards of treatment. Unfortunately, the frequency of patient complaints about side effects along with the well-known problems of patient compliance with glaucoma medications would appear to suggest that the latter treatment goal may not always be achieved, and in fact, some clinical investigators have reported pilot studies in which new glaucoma patients have been treated immediately with filtration surgery. In the proposed randomized clinical trial, functional status and life satisfaction will be measured and compared in two groups of patients with newly-diagnosed open angle glaucoma; patients in Group I will receive a standard sequence of medications, followed if necessary by laser trabeculoplasty, to control their intraocular pressure; patients randomized to Group Ii will receive immediate filtration surgery to reduce their intraocular pressure.